Precautions and Warnings With Esmolol

It's important to be aware of the precautions and warnings with esmolol before starting treatment. For example, esmolol can worsen heart failure and various other medical conditions. Therefore, it is important that you tell your healthcare provider about all existing conditions you have before starting esmolol. You should avoid taking esmolol altogether if you have severe heart failure, cardiogenic shock, or very slow heart rate.

What Should I Tell My Healthcare Provider Before Taking Esmolol?

You should talk with your healthcare provider prior to taking esmolol hydrochloride (Brevibloc®) if you have:
 
Also, let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
     
Make sure to tell your healthcare provider about all other medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.
 

Specific Esmolol Warnings and Precautions

Some warnings and precautions to be aware of prior to taking this drug include the following:
 
  • The most common side effect of esmolol is low blood pressure (hypotension). Your healthcare provider should monitor your blood pressure very carefully, especially if you already have low blood pressure.
     
  • Like all beta blockers, it is possible that esmolol may worsen or even cause heart failure. Because the medication is so short-acting, just stopping esmolol will usually reverse the problem. However, in some cases, serious problems may persist.
     
  • Esmolol should not be used to treat high blood pressure that is caused by low body temperature (hypothermia) during surgery.
     
  • Beta blockers can worsen breathing problems like asthma or COPD. If you have breathing problems, check with your healthcare provider before taking esmolol. While "cardioselective" beta blockers (whose actions are mostly limited to the heart and blood vessels) are less likely to cause this problem, it may still occur. It should be noted that esmolol loses its cardioselectivity at higher doses, meaning that it may have a significant effect on the lungs.
     
  • Beta blockers can mask some of the symptoms of low blood sugar (hypoglycemia), particularly the "racing heart" feeling. This can cause serious problems for people with diabetes, who need to be able to sense that they have low blood sugar (in order to correct it before it becomes life-threatening).
     
  • Esmolol can potentially interact with a number of other medications (see Drug Interactions With Esmolol).
     
  • If you have an anaphylactic allergy (the type that affects the entire body and often interferes with breathing), esmolol may make you more sensitive to the allergen and may make the usual treatments (such as epinephrine or an EpiPen®) less effective.
     
  • Your healthcare providers need to be very careful when preparing and administering esmolol. Accidentally making the IV too concentrated (resulting in an overdose) can cause death. Also, leakage of the medication outside the vein (known medically as extravasation) can result in very serious tissue and skin damage.
     
  • Esmolol is considered a pregnancy Category C medication. This means that it might not be safe during pregnancy, although the full risks are not currently known (see Esmolol and Pregnancy).
     
  • It is unknown if esmolol passes through breast milk in humans. Therefore, if you are breastfeeding or plan to start breastfeeding, discuss this with your healthcare provider prior to taking the drug (see Esmolol and Breastfeeding).
     
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Esmolol Drug Information

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